Eradicating this disease is Delhi’s biggest public health achievement since 1947, writes Gary CK Huang
On January 13, India will complete three years without reporting a single new case of the wild polio virus since a girl was found infected in the Howrah district of West Bengal on the same day in 2011. It will then officially be declared as polio-free, saving millions of children from this crippling but easily preventable disease.
This is no small feat for a country which till recently was the world's polio hotspot, accounting for half of all new cases between 1988 and 2009. Experts thought India would perhaps be the last country in the world to get rid of polio.
The Government, however, showed leadership and commitment to the cause. The World Health Assembly in 1988 launched the polio eradication campaign, in collaboration with WHO, UNICEF, Centers for Disease Control and Prevention and Rotary International. The Government became fully involved after a pilot immunisation project in 1994 in Delhi proved successful. In 1997, the National Polio Surveillance Project of WHO and Indian Government was established and two years later, an expert advisory group was set up to monitor the immunisation programme. This eventually went on to become India's most extensive public health monitoring system. The Indian Government rallied all stakeholders to launch an intense national mass immunisation campaign for the next two decades. Its results have now borne fruit.
Millions of Indian volunteers fan out every year on special immunisation days, administering oral vaccine to 172 million under-five children in house-to-house campaigns all across the country, effectively stopping the transmission of polio. This is perhaps India's biggest achievement in public health since Independence. The innovations and lessons learnt must be adapted and implemented in other countries. This would not only help give one final push for a polio-free world, it would also enable us to tackle other health challenges like malnutrition and infant mortality.
The success of India's polio campaign showcases the kind of change that is possible even in complex, low-income countries if the Government puts its mind to it. Members of Rotary International in the country are credited for getting the political and the bureaucratic establishment engaged in the campaign. They garnered political and bureaucratic support for the campaign by involving the President, the Prime Minister, Chief Ministers, State Health Ministers and local politicians.
India's polio campaign was not a one-horse show. The Government managed to channelise the energies of various partners from the country and the world. These included parents, community leaders, volunteers, care givers, the Rotary International members, the Global Polio Eradication Initiative, international agencies like the WHO and UNICEF, and India's corporate sector and philanthropists. It acted as the facilitator and coordinator, with impressive results. In India the partnership is reputed as seamless with one partner complementing the other and putting the cause before them.
The hallmark of the Indian polio campaign has been a voluntary cooperation from all stakeholders, rather than over-assertive enforcement by the state. Awareness about polio among the masses was raised by some successful publicity campaigns involving Bollywood celebrities like Amitabh Bachchan. In some areas of India with a significant minority population, local community-based organisations and the clergy were co-opted for the campaign. This triggered a change in social attitudes and ensured sustained high immunisation coverage among vulnerable groups.
Stopping polio in India would not have been possible without single-minded focus and perseverance from the Government and other stakeholders, which sparked many innovations along the way. The polio campaign was spread across almost two decades which saw many changes in Governments, yet its intensity was not allowed to dissipate. Every time there was a doubt in the feasibility of the campaign, partners particularly Rotary motivated and encouraged the Government and partners to carry on. All stakeholders fought to the finish.
Successful health campaigns to eradicate diseases need serious money. The Indian polio eradication effort needed billions of dollars over the years. Many stakeholders from public and private sector contributed funds, including the Government of India and Indian corporate with Rotary International investing as much as $1.2 billion till date — to India alone its contribution stands at $178 million. As far as country contribution goes, the Government since the past few years contributes the highest domestic resources than any country for the campaign.
People everywhere in the world can look at India's polio eradication story as inspiration to overcome other diseases like tuberculosis, measles and malaria that continue to plague much of humanity.
The key take-away is that we need to form partnerships, share our strengths and resources, and work together toward the common goal of meeting unmet medical needs and making more countries free from preventable diseases.